Text4Health On Its Way to Promoting Improved Public Health Outcomes

Need a reminder to take your medicine? Or are you craving a cigarette and need a pep talk to avoid the urge? HHS is there for you, ready to send a text message to help you out. And not only with smoking cessation; after almost a full year of research, HHS is well on its way to finding methods of improving public health via text messaging and other mobile health (mHealth) programs.

Currently, there are over 302 million wireless subscribers in the United States. Because only 25-50 percent of these subscribers own smart phones, the one wireless technology that spans across almost all cell phones is texting. According to a recent report, over 2.2 trillion text messages were sent in 2010. Almost 90% of teenagers have cell phones, with over half of them reporting that they use text messaging on a daily basis. In a sample study of low-income households on Medicaid, 80% of the patients recommended using text messaging daily. With statistics like these, it is easy to see where one might begin to realize its time to put this technology to work. In fact, several empirical studies suggest that using this text messaging technology will improve public health outcomes. It then becomes a question of what will work best.

Last year, HHS organized a Text4Health Task Force to attempt to gain some insight into what methods might work best. And now, the Text4Health Task Force has delivered its first set of recommendations since its inception in November 2010.

Develop further evidence on the effectiveness of health text messaging programs,

Explore and develop partnerships with other government agencies and with non-government organizations to create, implement and disseminate health text messaging and mHealth programs,

Establish an on-going “mHealth community of practice” group within HHS to meet regularly to discuss and coordinate mHealth issues, and “to systematically explore and discuss which topic areas or health problems might best be addressed by HHS via health text messaging and mobile technologies,”

Should “align [coordinate or integrate] health text messaging/mHealth activities with other HHS Health IT priorities,” such as “Electronic Health Records, Cloud Computing, Health Games,” and others, and

Should “conduct further research into the privacy and security risks associated with text messaging of health information and establish guidelines for managing such privacy/security issues.” For example, the report sites potential issues under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules, and further recommends that “mHealth issues should be discussed within the HHS Inter-Division Health IT Policy and Security Task Force.”

Although there is much research to be done, HHS continues to plow forward with some early programming. Initially, HHS is focusing mHealth programs on smoking cessation. The SmokeFreeTXT program, a mobile smoking cessation service specifically designed for teens and young adults across the United States, has just been launched by the National Cancer Institute (NCI) at the National Institutes of Health. This program is actually an extension of the core smoking cessation website, which receives between 70,000 – 100,000 visits per month.

“More than 70 percent of smokers want to quit, we are committed to providing evidence based information to smokers through emerging and innovative technology,” said HHS Secretary Kathleen Sebelius.

The NCI is also launching another texting program aimed at helping people quit smoking, and has developed a library of smoking cessation messages which provide the foundation for an interactive text-based intervention for adult smokers called QuitNowTXT. The text messaged in QuitNowTXT are designed to “offer tips, motivation, encouragement and facts based on information tailored to the user’s response and are available at http://smokefree.gov/hp.aspx.”

The Center for Disease Control has also jumped on board, and is promoting its own mobile web site, aimed at providing information on seasonal flu, H1N1 flu, and public health emergencies. People can sign up on their mHealth website to receive text messages as well.

With all the hype over HHS involving itself even further in mobile technology, there are at least some researchers providing cautionary advice. According to a recent report on the impact of EHealth, programs must be subject to serious scrutiny to truly discover their value. It is only through rigorous testing and research that we will be able to discover its true cost effectiveness.